New research sheds light on the specific genotypes and treatment results for hepatitis C virus (HCV) in areas where the disease is more prevalent, including Asia, Africa, and the Commonwealth of Independent States.¹

A team, led by AA Choudhry, Department of Gastroenterology, Chaudhry Hospital, looked at specific outcomes for patients with HCV in these regions.

The Need

There remain patient, government, payer, and provider-level barriers to better HCV treatment and care in regions around the world, including Asia, Africa, and the Commonwealth of Independent States. However, there has been patient registries created in these regions in an attempt to better understand the patterns of clinical care and outcomes in real-world settings.

“Concerns regarding treatment duration and cost, fear of side effects, lack of treatment coverage, limited access to medications or laboratory facilities, insufficient training for HCV management, and lack of referral to HCV providers by physicians, may affect the treatment plans and subsequent outcomes of HCV management,” the authors wrote. “These barriers are underpinned by the lack of adequate documentation of the treatment practices and outcomes in these regions.”

One potential way to identify and correct these barriers begins with patient-level registries.

The Study

In the prospective study, the investigators examined adult patients across 14 centers in Asia, Africa, and the Commonwealth of Independent States between 2018-2021. Each participant was treated with direct-acting antivirals (DAA). The majority of patients (62.2%; n = 296) were male and the mean age of the patient population was 49.8±12.6 years.

In addition, the majority of participants did not have any clinically relevant pre-existing medical conditions (71.8%), while 3.5% were using concomitant medications for pre-existing conditions.

The investigators sought a primary endpoint of the prevalence of HCV genotypes and DAAS strategies. They also looked at secondary endpoints of the efficacy and safety of various DAA regimens.

The team also identified HCV risk factors, including dental exposure (16.2%), frequent injections (10.3%), intravenous injectables (9.7%), blood and blood products transfusion (9%), and surgery/organ transplant (9%).

The study included 476 initial enrollees, 386 (81.1%) of which were included in the final analysis. The remaining 90 were lost during the follow-up period.

The most prevalent genotype observed was GT 3 (30.5%) and GT 1 (19%).However, patients with the GT 1 and GT 6 subtypes have higher sustained virologic response 12 cure rates (100%; n = 55, n = 24) followed by GT3 (95.9%, n = 94).

The most commonly prescribed treatment was Daclatasvir 60 mg/ Sofosbuvir (43.7%; n = 208). This was followed by Sofosbuvir/Ledipasvir (16.2%; n = 77) and Sofosbuvir/Velpatasvir (14.3%; n = 68).

The SVR 12 rates for 98.2% (n = 54) for Sofosbuvir/Ledipasvir, 97.6% (n = 35) for Sofosbuvir/Velpatasvir, and 90.8% (n = 128) for Daclatasvir/Sofosbuvir.

For safety, the investigators identified adverse events in 13 patients with 1 death that was not considered to be related to the treatment.

“Overall, sofosbuvir-based regimens were found to be safe and efficacious. GT 3 and 1 were the most prevalent HCV genotypes,” the authors wrote.

References:

Hadigal S. Registry to Understand Patient Characteristics, Treatment Patterns, and Therapy Outcomes in Adults with Chronic Hepatitis C Virus Infection in Asia, Africa, and Eastern Europe. J Gastro Hepato. 2023; V9(15): 1-8